DCH: comprehensive health solutions in Sirajdikhan

DCH reminds me of Partners in Health in that it is not just a clinic in the middle of nowhere, but rather a network of community health workers that travel to homes, organize courtyard meetings to educate about sanitation and other topics...in addition, it organizes women's cooperatives to empower the local women, teaches trades such as tailoring, and provides safe water options that are so essential to good health. In this sense, DCH provides not only health care services but comprehensive aid to development. It's a tangential example of the Comilla Model of development that was formulated in the sixties and later expanded throughout Bangladesh and abroad. It was this model that inspired Mohammad Yunus's Grameen Bank. The woman who was central in developing this model is today a gentle, grandmotherly figure, but we can imagine she was a true revolutionary of her time, earning a master's in the US when most women were barely educated and then doing much significant work that's earned her international service awards. She happens to be a relative of Shireen Miss, and I had the privilege of riding back with her from the (beautiful!! pictures to come) wedding reception tonight.

Here's an excerpt of a draft proposal to DFID (yes this is probably the umpteenth reference to anthro1825) for river sand filters. I wrote this, piecing together scraps of other old proposals. Skim through, and you will get a clearer idea of what we are doing, as well as the inconsistencies and shaky information I often work with. Part of my job here, as Dick said to me that first September day, is to lay down a foundation of the Harvard-American way of organizing and systemizing things that has been ingrained in me over the years.

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Context
Sirajdikhan is located in central Bangladesh, just south of the region of Dhaka, the capital district. Siradjdikhan is the second largest upazila in the Munsigonj district as measured by population and area. It covers 180.09 sq km. and supports a population of 241,000, according to the Statistical Book of Bangladesh, 2003. (updated population information??)

DCH has worked in Sirajdikhan since (what year?) providing comprehensive health and social care through its local clinic. In addition to basic healthcare that is offered free of cost to villagers who do not have the means to pay (is this true?) Trained community health workers conduct home visits to provide primary health care and lead courtyard meetings for sanitation and hygiene education. Medical officers (officers? Does this mean doctor?) from DCH’s central Dhaka hospital visits the Sirajdikhan local office weekly to provide secondary health care services (google this and check it is correct terminology) and patients are transported free of charge to the Dhaka hospital for necessary tertiary health care services. In addition to basic health services, DCH also educates villagers on environmental protection, enables them through teaching a trade such as tailoring, knitting, quilting, sewing, fishing, kitchen-gardening, or tree planting, and forms women’s cooperative societies to empower women. For all of these healthcare and ancillary services, each family of eight members pays 20 taka monthly.

Previous interventions
Through an extensive survey in Sirajdikhan conducted in 2001 and 2002 (DCH tested 18,631 tubewells, of a total of 19,436 total tubewells in Sirajdikhan: 805 wells were not tested because they were no longer functioning), it was revealed that 47% of the tubewells tested had arsenic concentrations above 0.05 mg/L, the Bangladesh national limit, and far above the WHO limit of 0.1 mg/L. These numbers mean that approximately 113,270 people in Sirajdikhan were consuming arsenic contaminated water. 134 arsenic patients were identified and treated at DCH (why so few, if 113270 people are drinking contaminated water? This number is not convincing, I'm really not moved by 134 patients, can we leave it out?)

In response to this alarming situation, DCH installed four river sand filter units with attached hand pump, 138 improved dugwells, 1122 rain water harvesting systems, 12 pond sand filter units with attached hand pump, and provided medical treatment to the arsenicosis patients during the period 2001-2005. (Did we stop providing arsenicosis treatment after 2005?) These safe water options were acceptable, affordable, and sustainable for the community. After installation, DCH trained the selected community caretakers to maintain these systems and gave the community ownership and responsibility for these systems.

This intervention provided 3,372 families (do we have this data in units of PEOPLE not families? Because we reference population in terms of people, we should stay consistent) of 23,362 families (How many people were served? Are these the health outcomes of all the SWOs we installed?) total village is 182 and total union is 14, noted that there are 5 villages having 100% arsenic contamination and the other 37 villages having 80% to 99% & 315 arsenic patients already identified in 36 villages in 13 unions. Therefore, only one union, where there was no arsenic patient, name of that union is Rajanagar.


04-05, Bangladesh government completed screening of all tubewells
80-100% arsenic contaminated area is 1st priority
60-80 is second priority

Current need
As of December 2007, DCH recorded 315 patients (seen in our clinic or in total?) in the Sirajdikhan district who need treatment for arsenicosis.
An estimated that 19,990 families (what is the definition of a family? what is this in number of people?) still do not have the access of safe water options. Most of them are still drinking and cooking with arsenic-contaminated water, putting them at high risk for arsenicosis. The right to water is a human right guaranteed in Article 24 of the Universal Declaration of Human Rights, and access to clean water and sanitation is critical to the achievement of the UN Millennium Development Goals.
In addition to providing new safe water options, there is also a need to re-test existing tubewells. Because the arsenic content in tubewells can vary with season, time, and other factors (is this true?) it is important to re-test tubewells every three or six (which is it? testing every 3 months would be twice as expensive) after they have originally been labeled as safe. Currently, the villagers who live near the DCH Sirajdikhan clinic come to request testing, and DCH has been able to help them with our existing funds. For villagers who live farther away, though, have not had their tubewells re-tested: it is necessary for an organization to be proactive in reaching out to and re-testing for remote villages. Many of the re-tests to date have shown that previously safe tubewells have become contaminated with arsenic. It is important to continue to identify unsafe wells and provide alternative safe water options to those villagers whose tubewells are no longer arsenic-free.